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Detection and Prediction of Bioprosthetic Aortic Valve Degeneration.
- Source :
-
Journal of the American College of Cardiology [J Am Coll Cardiol] 2019 Mar 19; Vol. 73 (10), pp. 1107-1119. - Publication Year :
- 2019
-
Abstract
- Background: Bioprosthetic aortic valve degeneration is increasingly common, often unheralded, and can have catastrophic consequences.<br />Objectives: The authors sought to assess whether <superscript>18</superscript> F-fluoride positron emission tomography (PET)-computed tomography (CT) can detect bioprosthetic aortic valve degeneration and predict valve dysfunction.<br />Methods: Explanted degenerate bioprosthetic valves were examined ex vivo. Patients with bioprosthetic aortic valves were recruited into 2 cohorts with and without prosthetic valve dysfunction and underwent in vivo contrast-enhanced CT angiography, <superscript>18</superscript> F-fluoride PET, and serial echocardiography during 2 years of follow-up.<br />Results: All ex vivo, degenerate bioprosthetic valves displayed <superscript>18</superscript> F-fluoride PET uptake that colocalized with tissue degeneration on histology. In 71 patients without known bioprosthesis dysfunction, 14 had abnormal leaflet pathology on CT, and 24 demonstrated <superscript>18</superscript> F-fluoride PET uptake (target-to-background ratio 1.55 [interquartile range (IQR): 1.44 to 1.88]). Patients with increased <superscript>18</superscript> F-fluoride uptake exhibited more rapid deterioration in valve function compared with those without (annualized change in peak transvalvular velocity 0.30 [IQR: 0.13 to 0.61] vs. 0.01 [IQR: -0.05 to 0.16] ms <superscript>-1</superscript> /year; p < 0.001). Indeed <superscript>18</superscript> F-fluoride uptake correlated with deterioration in all the conventional echocardiographic measures of valve function assessed (e.g., change in peak velocity, r = 0.72; p < 0.001). Each of the 10 patients who developed new overt bioprosthesis dysfunction during follow-up had evidence of <superscript>18</superscript> F-fluoride uptake at baseline (target-to-background ratio 1.89 [IQR: 1.46 to 2.59]). On multivariable analysis, <superscript>18</superscript> F-fluoride uptake was the only independent predictor of future bioprosthetic dysfunction.<br />Conclusions: <superscript>18</superscript> F-fluoride PET-CT identifies subclinical bioprosthetic valve degeneration, providing powerful prediction of subsequent valvular dysfunction and highlighting patients at risk of valve failure. This technique holds major promise in the diagnosis of valvular degeneration and the surveillance of patients with bioprosthetic valves. (18F-Fluoride Assessment of Aortic Bioprosthesis Durability and Outcome [18F-FAABULOUS]; NCT02304276).<br /> (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Aortic Valve Stenosis diagnosis
Calcinosis diagnosis
Calcinosis etiology
Computed Tomography Angiography methods
Echocardiography methods
Female
Fluorodeoxyglucose F18 pharmacology
Humans
Male
Predictive Value of Tests
Prognosis
Radiopharmaceuticals pharmacology
Aortic Valve physiopathology
Aortic Valve surgery
Aortic Valve Insufficiency diagnosis
Aortic Valve Insufficiency etiology
Aortic Valve Stenosis surgery
Bioprosthesis
Heart Valve Prosthesis
Positron Emission Tomography Computed Tomography methods
Postoperative Complications diagnosis
Postoperative Complications etiology
Prosthesis Failure adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1558-3597
- Volume :
- 73
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- Journal of the American College of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 30871693
- Full Text :
- https://doi.org/10.1016/j.jacc.2018.12.056